Early Palliative Home Care versus Hospital Care for Patients with Hematologic Malignancies: A Cost-Effectiveness Study

Cartoni, Claudio; Breccia, Massimo; Giesinger, Johannes; Baldacci, Erminia; Carmosino, Ida; Annechini, Giorgia; Palumbo, Giovanna; Armiento, Daniele; Niscola, Pasquale; Tendas, Andrea; Brunetti, Gregorio Antonio; Minotti, Clara; Marini, Maria Giulia; Reale, Luigi; Martone, Nicoletta; Martelli, Maurizio; Efficace, Fabio

doi:10.1089/jpm.2020.0396

Cited by 13 publications

(11 citation statements)

References 19 publications

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“…Domiciliary assistance could be the right answer to this unmet need. Even if, up to now, this approach was employed especially for patients in palliative treatments, 9,10 it is time to move forward and use home-care assistance to treat frail patients with active therapies.…”

Section: Discussionmentioning

confidence: 99%

“…Home‐care service could overcome these difficulties, making HMAs treatment available also in patients otherwise excluded from active therapies. At present, however, there are only scarce data on feasibility, efficacy and safety of domiciliary management of such patients with HMAs, 7,8 and home‐care assistance is mostly devoted to palliative and end‐of‐life care 9,10 …”

Section: Introductionmentioning

confidence: 99%

“…At present, however, there are only scarce data on feasibility, efficacy and safety of domiciliary management of such patients with HMAs, 7,8 and home-care assistance is mostly devoted to palliative and end-of-life care. 9,10 In the Viterbo province, Italy, a Domiciliary Hematologic Care Unit (DHCU) for clinical assistance to frail patients with hemopathies in active therapy is operative. Aim of this study was to evaluate the role of the DHCU compared to standard DH/A setting in the frontline treatment with HMAS +/À VTX of patients with AML/HR-MDS.…”

Section: Introductionmentioning

confidence: 99%

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Treatment in patients with acute myeloid leukemia/high‐risk myelodysplastic syndrome with hypomethylating agents: Day‐hospital management compared to home care setting

Trapè

Angelis

Morucci

et al. 2023

European J of Haematology

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Objectives: Aim of the study was to evaluate the role of a Domiciliary Hematologic Care Unit (DHCU) compared to standard DH setting in the active frontline treatment with hypomethylating agents (HMAs) +/À venetoclax of frail patients with acute myelogenous leukemia/high-risk myelodysplastic syndromes (AML/HR-MDS).Methods: All patients with newly diagnosed AML/HR-MDS unfit for intensive care and treated frontline with HMAs from January 2010 to April 2021 were retrospectively included.Results: Among 112 patients (62 AML/50 HR-MDS), 69 (61.6%) were treated in a standard DH setting and 43 (38.4%) were followed by DHCU, allocated to DH or DHCU by responsible physician. Overall response rate was 29/69 (42.0%) in DH versus 19/43 (44.1%) in DHCU (p = .797). Median response duration was 8.7 months (95%CI 7.0-10.3) in DH versus 13.0 months ) in DHCU (p = .460). Infections were also equally reported. Median overall survival of patients treated in DH was 13.7 months (95%CI 9.9-17.4) compared to 13.0 months (95%CI 6.7-19.3) of patients managed by DHCU (p = .753).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Treatment in patients with acute myeloid leukemia/high‐risk myelodysplastic syndrome with hypomethylating agents: Day‐hospital management compared to home care setting

Trapè

Angelis

Morucci

et al. 2023

European J of Haematology

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“…Regarding the Italian experience, there is only one qualitative survey analyzing the cognitive barriers and facilitators of health professionals who refer patients to PC [14]. Only two other studies have shown support for the early integration of PC and hematology, demonstrating that this can effectively improve the quality of life and signi cantly reduce costs for health services [20,21].…”

Section: Introductionmentioning

confidence: 99%

A multicenter survey on the perception of palliative care among the health professionals working in hematology

Lorenzo,

Mozzi,

Salmaso

et al. 2023

Preprint

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Introduction Patients with hematological malignancies have less access to Palliative Care and have more delayed referrals than patients with solid tumors. Why does this occur? This survey aims to analyze the perceptions of Palliative Care of health professionals who treat hematological patients and to identify the barriers and facilitators when patients are referred to Palliative Care services. Method This is a multicenter, exploratory, descriptive web-based survey. A questionnaire was submitted to the medical and nursing staff at five Italian Hematological units and San Marino’s hospital. The survey covered accessibility, knowledge, education, perceived barriers and facilitators, and personal experiences concerning Palliative Care. Quantitative and qualitative analyses were performed. Results The number of completed questionnaires was 142/320: 96 by nurses and 46 by physicians. It emerged that 96.5% of participants supported integration of hematology and Palliative Care. It was found that 50.7% of participants had a Palliative Care team at their hospital, though only 16.2% had attended a specific course within their hospital, and 70.4% of them were familiar with the role of a palliativist. Nearly half of professionals (49.2%) agreed to refer patients to Palliative Care at the beginning of the care pathway, 52.8% when the prognosis is less than three months or with incoercible symptoms. The percentages of physicians and nurses agreeing to transfusions even in the final stages of the disease were 60.9% and 55.3%, respectively. Concerning facilitators, 65.5% of physicians and 47.2% of nurses considered an in-hospital Palliative Care team and a case manager to be fundamental; 82.4% of participants highlighted the importance of Palliative Care training. Conclusion The results show that professionals have a positive attitude towards achieving multidisciplinary integration. The small number of referrals may be due to clinical, cultural, educational, organizational, and resource issues.

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“…Di Pollina et al reported that integrated HC reduces unnecessary hospitalizations and emergency visits among frail elderly patients [ 27 ]. Wong et al reported that a home-based palliative care program was a more cost-effective option than usual palliative care for people with heart failure [ 28 ], and Cartoni et al found similar results, reporting that palliative HC costs were lower than hospital care costs for patients with hematological malignancies [ 29 ].…”

Section: Introductionmentioning

confidence: 99%

A social network analysis to explore collaborative practice in home care: research protocol

Schorderet

Bastiaenen

Verloo

et al. 2022

BMC Health Serv Res

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Background The conceptualization of the home as a care environment and maintaining a high standard of care requires different professionals to collaborate. This study will explore collaborative practice in home care, needs and expectations of the stakeholders involved, and identify their roles and tasks. Secondly, it will investigate possible strategies to improve home care management and, more particularly, optimize collaborative practice in home care. Methods The study will be conducted during three distinct consecutive phases, within a multiphase mixed-methods design. Phase 1 will use a quantitative approach in which a social network analysis will be conducted to have an overview of collaborative practice in home care in French-speaking Switzerland. Phases 2 and 3 will be qualitative and focus on three different situations involving different locations (rural and urban) and different home care functioning (home care provided by agencies and home care providing by independent caregivers). In each situation, semi-structured interviews will be conducted with home care recipients and their home caregivers. In phase 2, results of phase 1’s network analysis will be discussed, such as roles, needs, and expectations of all stakeholders involved in home care. In phase 3, phase 2’s findings will be discussed and strategies to improve home care and to optimize collaborative practice will be explored. Discussion Over the past years, home care has grown considerably. Therefore, more and more different caregivers are involved in the recipients' homes. Since optimal coordination between these different caregivers is a prerequisite for quality and safe care, it is essential to investigate the existing collaborative practice and how it is functioning. This study will provide knowledge on roles, needs and expectations of different caregivers involved in home care. It will also allow for strategies to optimize collaborative practice and thus ensure comprehensive care for recipients. Finally, it will serve as a basis for future studies that can be conducted to address identified needs.

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Early Palliative Home Care versus Hospital Care for Patients with Hematologic Malignancies: A Cost-Effectiveness Study

Cited by 13 publications

References 19 publications

Treatment in patients with acute myeloid leukemia/high‐risk myelodysplastic syndrome with hypomethylating agents: Day‐hospital management compared to home care setting

Treatment in patients with acute myeloid leukemia/high‐risk myelodysplastic syndrome with hypomethylating agents: Day‐hospital management compared to home care setting

A multicenter survey on the perception of palliative care among the health professionals working in hematology

A social network analysis to explore collaborative practice in home care: research protocol

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